Healthcare Provider Details

I. General information

NPI: 1558655779
Provider Name (Legal Business Name): JOSHUA STEPHEN WEINGARTNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3960 W. TECUMSEH ROAD SUITE 120
NORMAN OK
73072
US

IV. Provider business mailing address

P.O. BOX 722225
NORMAN OK
73070
US

V. Phone/Fax

Practice location:
  • Phone: 405-217-3886
  • Fax: 405-217-3419
Mailing address:
  • Phone: 405-292-5500
  • Fax: 405-292-5505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number28508
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: